Acute Hemispheric Ischemic Stroke Research Articles

Plasma Levels of Neuron/Glia-Derived Apoptotic Bodies, an In Vivo Biomarker of Apoptosis, Predicts Infarct Growth and Functional Outcome in Patients with Ischemic Stroke.

Evidence demonstrating the involvement of apoptosis in the death of the potentially salvageable area (penumbra zone) in patients during stroke remains limited. Our aim was to investigate whether apoptotic processes occur in penumbral brain tissue by analyzing circulating neuron- and glia-derived apoptotic bodies (CNS-ApBs), which are vesicles released into the bloodstream during the late stage of apoptosis. We have also assessed the clinical utility of plasma neuronal and glial apoptotic bodies in predicting early neurological evolution and functional outcome. The study included a total of 71 patients with acute hemispheric ischemic stroke (73 ± 10years; 30 women). Blood samples were collected from these patients immediately upon arrival at the hospital (within 9h) and at 24 and 72h after symptom onset. Subsequently, isolation, quantification, and phenotypic characterization of CNS-ApBs during the first 72h post-stroke were performed using centrifugation and flow cytometry techniques. We found a correlation between infarct growth and final infarct size with the amount of plasma CNS-ApBs detected in the first 72h after stroke. In addition, patients with neurological worsening (progressive ischemic stroke) had higher plasma levels of CNS-ApBs at 24h after symptom onset than those with a stable or improving course. Circulating CNS-ApB concentration was further associated with patients' functional prognosis. In conclusion, apoptosis may play an important role in the growth of the cerebral infarct area and plasma CNS-ApB quantification could be used as a predictive marker of penumbra death, neurological deterioration, and functional outcome in patients with ischemic stroke.

Prognostic value of blood pressure in the acute period of hemispheric ischemic stroke

Aim. To study changes in blood pressure (BP) in patients with acute hemispheric ischemic stroke (AIS), to correlate BP in patients with AIS with BP in patients with chronic brain ischemia, and to study the association of various BP indices with stroke severity and recovery.Material and methods. We included 235 patients with hemispheric AIS (age 64±11 years; women, 41,3%). BP was assessed 6 times as follows: by patient’s self-measurement during the month before the stroke onset, in the ambulance, in the admission department, in the intensive care unit using 24-hour blood pressure monitoring (BPM), in the neurologic department (BPM), and 90 days after stroke. In patients with chronic cerebral ischemia (178 patients, age 62±13 years, 46,1% women), BP was assessed 3 times: by patient’s self-measurement during the month before hospitalization, in the admission department, and in the neurologic department (BPM).Results. Patients with AIS within the month before stroke had higher systolic and pulse pressure than patients with chronic cerebral ischemia. During the acute stroke period, patients with AIS despite reaching target systolic and diastolic BP had significantly increased variability of systolic and diastolic BP compared to patients with chronic brain ischemia. Systolic BP ≥160 mm Hg recorded consecutively in ambulance, in admission department, and in intensive care unit, as well as pulse pressure ≥60 mm Hg, and systolic BP variability ≥18 mm Hg recorded on day 1-2 and day 9-10, positively correlated with National Institute of Health Stroke Scale (NIHSS) score (r≥0,37, p≤0,0017) on day 10 and with modified Rankin Scale (mRS) score (r≥0,29, p≤0,006) on day 90.Conclusion. Patients with hemispheric AIS had significantly higher systolic BP and pulse pressure within the month before stroke. During the first 10 days of AIS persistent increase in systolic, diastolic, and pulse pressure, and BP variability was associated with more severe stroke and less favorable outcome. These results should be taken into account when administering antihypertensive treatment.

Зрительная агнозия в клинике острого ишемического инсульта: частота встречаемости и связь с другими когнитивными нарушениями

Study Objective: To identify the frequency of the types of visual agnosia (VA), their association with one another and with other neuropsychologic disorders in patients with acute hemispheric non-lacunar ischemic stroke (IS). Study Design: retrospective study. Materials and Methods. We followed up 104 patients with acute IS (mean age: 66.7 ± 9.4 years old), who underwent neurological, neuropsychologic, neuroimaging and ophthalmological examination. Study Results. VA was diagnosed in 52% of patients; in the majority of cases, the condition was diagnosed on the basis of deep neuropsychologic tests only, and it was asymptomatic. VA structure was dominated by unilateral visual neglect (21%), apraxia (20%) and object VA (18%). Object VA was the most frequent clinical sign (8 (42%) out of 19 patients). Spatial VA (including neglect and apraxia) correlated with the rate of regulatory dysfunction and short-term visual memory impairment; object VA — with regulatory dysfunction; facial VA — only with a decrease in short-term visual memory. The cluster analysis allowed identifying relatively homogeneous groups of patients: 1) no VA; 2) impaired spacial gnosis; 3) with impaired objects and facial gnosis. Conclusion. VA is diagnosed in a half of patients with acute hemispheric non-lacunar IS and is mostly asymptomatic. Spatial VA is predominant. Spacial, object and facial VA have statistically significant association with frontal lobe dysfunction; spacial and facial — with short-term visual memory impairments. Two most common combinations of various VA types in acute IS were identified — visual and special disorders and impaired object and face recognition. Keywords: visual agnosia, visual and spacial disorders, stroke, cluster analysis.

Pentosidine, advanced glycation end product, in acute ischaemic stroke patients with and without atrial rhythm disturbances.

Aim of the present study was to investigate the role of pentosidine as a potential biological marker for AF in an AIS patient group. Sixty-three acute ischaemic hemispheric stroke patients were recruited and divided into two groups according to the presumed underlying mechanism: with or without atrial rhythm disorders. Ten healthy volunteers were a reference group for serum level of pentosidine. Carotid artery ultrasound was performed, and common carotid artery stiffness and intima-media thickness were measured. Serum levels of pentosidine and selected routine biochemical risk factors for atherosclerosis (cholesterol and its lipoprotein fractions, homocysteine) were examined. A higher serum level of pentosidine was observed in patients without atrial fibrillation (1,509 ± 485.13pmol/ml); a statistically significant difference was observed compared to the reference group (1,041.52 ± 411.17pmol/ml; p = 0.01), but not the AF patients (1,438.19 ± 495.97pmol/ml; p = 0.59). No significant difference in the non-AF group compared to the AF group for carotid intima-media thickness (IMT)/stiffness and pentosidine serum level was recorded. A higher serum level of pentosidine was observed in AIS patients without atrial fibrillation compared to the healthy volunteers. According to the results of the present study, no difference between these patients in the selected risk factors of atherosclerosis were observed. Further studies are needed to identify a reliable marker of AF that would bring added value to the standard diagnostic workup after acute ischaemic stroke.

Dissociation of visual extinction and neglect in the left hemisphere

Visual neglect and extinction are two distinct visuospatial attention deficits that frequently occur after right hemisphere cerebral stroke. However, their different lesion profiles remain a matter of debate. In the left hemisphere, a domain-general dual-loop model with distinct computational abilities onto which several cognitive functions may project, has been proposed: a dorsal stream for sensori-motor mapping in time and space and a ventral stream for comprehension and representation of concepts. We wondered whether such a distinction may apply to visual extinction and neglect in left hemisphere lesions. Of 165 prospectively studied patients with acute left hemispheric ischemic stroke with a single lesion on MRI, 122 had no visuospatial attention deficit, 10 had extinction, 31 neglect and 2 had both, visual extinction and neglect. Voxel-based-lesion-symptom mapping (VLSM, FDR<.05) showed a clear anatomical dissociation. Extinction occurred after damage to the parietal cortex (anterior bank of the intraparietal sulcus, inferior parietal lobe, and supramarginal gyrus), while visual neglect occurred after damage mainly to the temporal lobe (superior and middle temporal lobe, anterior temporal pole), inferior ventral premotor cortex, frontal operculum, angular gyrus, and insula. Direct comparison of both conditions linked extinction to intraparietal sulcus and supramarginal gyrus (FDR<.05). Thus, in the left hemisphere extinction seems to be related to dorsal stream lesions, whereas neglect maps more on the ventral stream. These data cannot be generalized to the right hemisphere. However, a domain-general point-of-view may stimulate discussion on visuospatial attention processing also in the right hemisphere.

Зрительная объектная агнозия и агнозия новых топографических ориентиров у пациентов с острым полушарным ишемическим инсультом

The purpose — to estimate the frequency of visual general objects agnosia and novel landmarks agnosia in patients with acute ischemic stroke and to describe the clinical manifestations of these phenomena and association between them. Materil and methods. 75 patients with ischemic stroke were enrolled. Computed tomography and/or magnetic resonance scan to confirm the ischemic lesion, neurological, ophthalmological and neuropsychological examination were performed in all patients. Visual perception skills (gnosis) were measured by Birmingham Object Recognition Battery tests and authors’ Novel landmarks recognition test. Results. 8 out of 75 patients (10,7%) had visual agnosia documented by the neuropsychological testing, of these 3 patients had question-induced complaints («clinically evident» agnosia, group 1) and 5 patients had no complaints («clinically blurred» agnosia, group 2). 67 patients (89,3%) were not agnostic (group 3). The patients of the 1st and 2nd groups performed perception (gnosis) test significantly worse compared with those of the 3rd group while group 1 demonstrated significantly worse test results than group 2. A significant positive correlation was found between the results of Birmingham Object Recognition Battery tests and the Novel landmarks recognition test. Conclusion. General objects and landmarks recognition is impaired in 10,7% patients with acute ischemic hemispheric stroke. As a rule, general object agnosia is associated with landmark agnosia. Visual general objects and landmarks agnosia may be «clinically evident» verified by the patients’ question-induced complaints as well as by the results of neuropsychological testing, or «clinically blurred», verified only by testing. The test results were statistically significantly worse in «clinically evident» than in «clinically blurred» visual agnosia.

Prediction of the Lethal Outcome of Acute Recurrent Cerebral Ischemic Hemispheric Stroke.

Background and objectives. Stroke-induced mortality is the third most common cause of death in developed countries. Intense interest has focused on the recurrent ischemic stroke, which rate makes up 30% during first 5 years after first-ever stroke. This work aims to develop criteria for the prediction of acute recurrent cerebral ischemic hemispheric stroke (RCIHS) outcome on the basis of comprehensive baseline clinical, laboratory, and neuroimaging examinations. Materials and Methods. One hundred thirty-six patients (71 males and 65 females, median age 74 (65; 78)) with acute RCIHS were enrolled in the study. All patients underwent a detailed clinical and neurological examination using National Institutes of Health Stroke Scale (NIHSS), computed tomography of the brain, hematological, and biochemical investigations. In order to detect the dependent and independent risk factors of the lethal outcome of the acute period of RCIHS, univariable and multivariable regression analysis were conducted. A receiver operating characteristic (ROC) analysis with the calculation of sensitivity and specificity was performed to determine the prediction variables. Results. Twenty-five patients died. The independent predictors of the lethal outcome of acute RCIHS were: Baseline NIHSS score (OR 95% CІ 1.33 (1.08–1.64), p = 0.0003), septum pellucidum displacement (OR 95% CI 1.53 (1.17–2.00), p = 0.0021), glucose serum level (OR 95% CI 1.28 (1.09–1.50), p = 0.0022), neutrophil-to-lymphocyte ratio (OR 95% CI 1.11 (1.00–1.21), p = 0.0303). The mathematical model, which included these variables was developed and it could determine the prognosis of lethal outcome of the acute RCIHS with an accuracy of 86.8% (AUC = 0.88 ± 0.04 (0.88–0.93), p < 0.0001).

Adipokines level and insulin resistance in abdominally obese patients with acute ischemic non-lacunar hemispheric stroke

It has been examined serum concentrations of adiponectin, leptin and insulin resistance HOMA-IR index among patients with abdominal obesity II class and normal body weight patients in the acute phase of ischemic non-lacunar (atherothrombotic and cardioembolic) hemispheric strokes. There was absence of any significant difference in adipokines concentration and insulin resistance in normal body weight patients with acute stroke. Under the conditions of acute ischemic non-lacunar hemispheric stroke, patients with abdominal obesity II class have sustained reduction of adiponectin serum level at 1st and 10th day after stroke and transient elevation of leptin serum level, as well as HOMA-IR index at 1st day with subsequent return to basal values on the 10th day. The extents of these neuroendocrine changes in abdominally obese patients have a direct association with cerebral infarction volumes. These neuroendocrine peculiarities may be, at least partly, one reason of more severe stroke in abdominally obese patients.

Clinical and brain bioelectric features in patients with acute recurrent cerebral hemispheric ischemic stroke depending on acute disease period outcome

Objective — to study clinical‑neurophysiological correlations in patients with recurrent cerebral hemispheric ischemic stroke (RCHIS) depending on the outcome of the acute period of the disease.Methods and subjects. Complex clinical‑neurological and computer‑electroencephalographic examination of 41 patients (22 (53.6 %) men and 19 (46.4 %) women, mean age 71 (68 — 72)) with acute RCHIS was performed. All patients underwent neurological examination at the first day of the disease by National Institute of Health Stroke Scale (NIHSS) and by Modified Rankin Scale (mRS) at 21st day. The computed tomography as well as electroencephalography of the brain was performed at baseline.Results. The patient did not differ in gender structure, lateralization and localization of RCHIS. The tendency of higher values of the relative spectral power of d‑rhythm, q‑rhythm, DAR and TAR ratio in the affected hemisphere among all cohort of patients was revealed. It was established that patients with an unfavorable outcome of the acute RCHIS at onset of the disease were characterized by higher levels of relative spectral power of d‑rhythm in both hemispheres of the brain. Patients with favorable functional outcome of RCHIS are characterized by dominance of blo‑rhythm and b‑rhythm in the affected hemisphere as well as by dominance of alo‑rhythm and a‑rhythm in the intact hemisphere.Conclusions. It was found that functional outcome of acute RCHIS depend on the following parameters: absolute spectral power of d‑rhythm, relative spectral power of d‑rhythm, relative spectral power of q‑rhythm in affected hemisphere and relative spectral power d‑rhythm in the intact hemisphere and as well as DAR ration in affected and intact hemispheres.

F72. Contralesional brain activity in acute ischemic stroke

The non-injured, contralateral hemisphere is increasingly acknowledged in recovery from acute ischemic stroke. We estimate the value of conventional EEG recordings for identification of contralateral hemisphere involvement in relation to functional recovery. We analyzed two-minute epochs from 21 electrode EEG registrations from 18 patients with acute hemispheric ischemic stroke and compared with 18 age-matched controls. Outcome was dichotomized as good (mRS 0–2) or poor (mRS 3–5 or death) at three months. Effects of the infarct on the ipsi- and contralateral hemispheres were analyzed by the delta/alpha ratio (DAR) and two measures of functional connectivity (magnitude squared coherence (MSC) and weighted phase lag index (WPLI)). DAR was higher in patients than in controls, both in the ipsilateral and in the contralateral hemisphere (median 4.5 ± 6.7 ipsilateral and 2.4 ± 2.0 contralateral vs. 0.5 ± 0.5 in the control group, P < 0.001), indicating robust EEG changes in both lesioned and non-lesioned hemisphere. MSC and WPLI in the alpha and beta frequency bands were lower in patients than in controls in both hemispheres, indicating clear disturbances of functional connectivity (P < 0.05). In the poor outcome group, contralateral MSC and WPLI were lower than in the good outcome group, although these differences did not reach statistical significance. Short conventional EEG measurements show robust changes of brain activity and functional connectivity in both ipsilateral and contralateral hemisphere of patients with acute ischemic stroke. Changes of remote functional connectivity tend to interact with functional recovery. Associations between contralateral functional connectivity measures and incidence of apathy and depression are currently analyzed and will be presented.

Contralesional Brain Activity in Acute Ischemic Stroke

Background: The noninjured, contralateral hemisphere is increasingly acknowledged in the process of recovery from acute ischemic stroke. We estimated the value of conventional electroencephalography (EEG) recordings for identifying contralateral hemisphere involvement in relation to functional recovery. Methods: We analyzed 2-min epochs from 21 electrode EEG registrations of 18 patients with acute hemispheric ischemic stroke and compared with 18 age-matched controls. Outcome was dichotomized as good (modified Rankin Scale [mRS] 0–2) or poor (mRS 3–5 or death) at 3 months. Effects of the infarct on the ipsi-and contralateral hemispheres were analyzed by the delta/alpha ratio (DAR) and 2 measures of functional connectivity (magnitude squared coherence [MSC] and weighted phase lag index [WPLI]). Results: DAR was higher in patients than in controls, both in the ipsilateral and in the contralateral hemisphere (median 4.5 ± 6.7 ipsilateral and 2.4 ± 2.0 contralateral vs. 0.5 ± 0.5 in the control group, p < 0.001), indicating robust EEG changes in both lesioned and non-lesioned hemisphere. MSC and WPLI in the alpha and beta frequency bands were lower in patients than in controls in both hemispheres, indicating clear disturbances of functional connectivity (p < 0.05). In the poor outcome group, contralateral MSC and WPLI were lower than in the good outcome group, although these differences did not reach statistical significance. Conclusions: Short conventional EEG measurements show robust changes of brain activity and functional connectivity in both ipsilateral and contralateral hemispheres of patients with acute ischemic stroke. Changes of remote functional connectivity tend to interact with functional recovery. Future studies should estimate predictive values for individual patients and interactions with plasticity enhancing treatments.

Correction to: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

Correction to: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

Diverging lesion and connectivity patterns influence early and late swallowing recovery after hemispheric stroke.

Knowledge about the recovery of oral intake after hemispheric stroke is important to guide therapeutic decisions, including the administration of enteral tube feeding and the choice of the appropriate feeding route. They aimed to determine the localization and connectivity of lesions in impaired recovery versus recovered swallowing after initially dysphagic stroke. Sixty-two acute ischemic hemispheric stroke patients with impaired oral intake were included in a prospective observational cohort study. Voxel-based lesion-symptom mapping and probabilistic tractography were used to determine the association of lesion location and connectivity with impaired recovery of oral intake ≥7 days (indication for early tube feeding) and ≥4 weeks (indication for percutaneous endoscopic gastrostomy feeding) after stroke. Two distinct patterns influencing recovery of swallowing were recognized. Firstly, impaired recovery of oral intake after ≥7 days was significantly associated with lesions of the superior corona radiata (65% of statistical map, P < 0.05). The affected fibers were connected with the thalamus, primary motor, and supplemental motor areas and the basal ganglia. Secondly, impaired recovery of oral intake after ≥4 weeks significantly correlated with lesions of the anterior insula (54% of statistical map, P < 0.05), which was connected to adjacent operculo-insular areas of deglutition. These findings indicate that early swallowing recovery is influenced by white matter lesions disrupting thalamic and corticobulbar projection fibers. Late recovery is determined by specific cortical lesions affecting association fibers. This knowledge may help clinicians to identify patients at risk of prolonged swallowing problems that would benefit from enteral tube feeding. Hum Brain Mapp 38:2165-2176, 2017. © 2017 Wiley Periodicals, Inc.

Sympathetic skin response in acute ischemic stroke - Hemispheric asymmetry

Modern knowledge indicates greater scope and complexity of autonomic dysfunction after acute stroke. In addition to cardiovascular and respiratory disorders there are disturbances in sweat regulation and the responses of the sympathetic skin reflex in cerebrovascular disease. Bilateral changes in the parameters of the sympathetic skin response, as a result of unilateral cortical lesions are associated with the influence of inhibitory or stimulatory effects of the cerebral cortex and the reticular formation, which have a complex association with the contralateral cortical structures of the sympathetic system. The results of our study of patients with acute hemispheric ischemic stroke showed significant difference in the amplitude and latency between the affected and unaffected limbs, only in the group of patients with ischemic stroke in the territory of the right middle cerebral artery with involvement of the insular cortex. When we compared our results from patients with stroke in the left hemisphere with those with stroke the in right hemisphere, we established longer latency times and lower amplitudes in patients with right hemispheric strokes, The most marked ones are the abnormal values in patients with ischemic stroke in the territory of the right middle cerebral artery with involvement of the insular cortex .

Ambulatory blood pressure monitoring in essential hypertensive patients with acute ischaemic stroke

Blood pressure (BP) has been identified as a risk factor for various health disorders, including stroke onsets. Hypertension is one of the crucial health problem among adult Ukrainian. Due to the importance of elevated BP in stroke causality, BP measurement remains critical. However, it is limited information about value in clinical practice of ambulatory blood pressure monitoring (ABPM) data in hypertensive patients with inadequately controlled BP with acute stroke compared with those individuals who has no vascular onset. The aim of the study was to determine ABPM parameters in essential hypertensive patients with ischaemic hemisphere stroke. Materials and methods. A total of 114 study participants were analyzed (mean age 62 (56;72) years, 40 % women). We divided them into two groups according to the level of 24-h systolic BP (SBP) and diastolic BP (DBP), and the results of clinical examination. The first group (n=83) were inadequately controlled essential hypertensive individuals with high systolic or/and diastolic BP level according to the ABMP results, and the second one (n=31) were EH patients with an acute hemispheric ischaemic stroke (IS). Diagnosis of stroke was confirmed with clinical examination and computed tomography scan or magnetic resonance imaging results, and ABPM was conducted in 4.2±2.3 days after the stroke onset. Results. We had statistician difference (p<0.001) between groups of such parameters, as average SBP (diurnal, daytime, nighttime); diurnal pulse BP; SBP load (p<0.05); the diurnal AASI (p<0.05); circadian rhythm of DBP (p<0.05). No differences were found between the groups in morning surge calculated as speed and amplitude of the BP climbed in morning hours both for SBP (P=0.422 and P=0.395, respectively) and DBP (P=0.860 and P=0.337, respectively). Conclusion . In the present study, we evaluated the ABPM parameters in inadequately controlled essential hypertensive individuals with and without acute ischaemic hemispheric stroke. There was no statistical difference in ABPM parameters as for diastolic BP (averages, BP load) and for systolic BP (some parameters of BP load, variability). Meanwhile, there was statistician difference in systolic BP profile (averages, BP load, and the circadian index), pulse BP and the diurnal AASI.

Arterial blood pressure and heart rate response in patients with acute ischemic stroke - Correlation with the severity of cardiovascular autonomic dysfunction

Background and purpose: Despite numerous studies, the mechanisms of blood pressure and heart rate regulation in cerebrovascular diseases remain not completely understood. The aim of the study was to determine the changes in blood pressure (BP) and heart rate (HR) in patients with an acute hemispheric ischemic stroke and to seek a relation to the severity of the cardiovascular autonomic dysfunction. Methods: 20 healthy volunteers and 50 patients with an acute hemispheric ischemic stroke participated in the study. The values of BP and HR were registered. Cardiovascular autonomous disorders were examined with Ewing battery tests. Patients were divided into two groups according to the severity of the autonomous disorders. Results: Elevated BP values at admission were observed in 56% of our patients, and significantly higher values of systolic blood pressure (SBP) (p <0,001), diastolic blood pressure (DBP) (p = 0,001), and mean arterial pressure (p <0,001), as well as of the heart rate (p = 0,027) were found, compared to the control group. The most significantly increased values of the indicators were reported in patients with a stroke in the territory of the right middle cerebral artery with an involvement of the insular cortex. The results of the t-test performed, showed correlation only between the systolic blood pressure and the severity of the autonomic dysfunction, the values being significantly higher in patients with severe autonomic disorders (t = -2,14; p = 0.036). Conclusion: A variability in BP and HR with a tendency to increase was observed in patients with an acute hemispheric ischemic stroke (ICS) compared to controls, with the highest values reported in patients with ICS in the territory of right middle cerebral artery (TRMCA) with the involvement of the insular cortex (IC). A positive correlation was found between the values of systolic blood pressure (SBP) and the severity of autonomic dysfunction (AD).

Effect of cortexin on the quality of life in the early rehabilitative period after hemispheric ischemic stroke

To study the neuroprotective effect of a repeated course of low dose cortexin therapy on the quality of life in the early rehabilitative period after hemispheric ischemic stroke (IS). 90 patients were divided into group 1 treated with cortexin (10 mg i/m twice daily (morning and afternoon) in addition to basal treatment, group 2 given the repeated course of the same treatment, and control group (basal therapy alone). The standard SF-36 questionnaire was used to assess the quality of life. Treatment of patients following acute hemispheric ischemic stroke with cortexin (10 mg i/m twice daily) and the repeated course of the same treatment after 10 days resulted in the accelerated and more complete normalization of the quality of life in the early rehabilitation petriod (starting from days 21-27 days after the onset of disease) than in the patients given a single course of cortexin therapy or basal treatment alone.

Changes of deceleration and acceleration capacity of heart rate in patients with acute hemispheric ischemic stroke.

Background and purposeAutonomic dysfunction is common after stroke, which is correlated with unfavorable outcome. Phase-rectified signal averaging is a newly developed technique for assessing cardiac autonomic function, by detecting sympathetic and vagal nerve activity separately through calculating acceleration capacity (AC) and deceleration capacity (DC) of heart rate. In this study, we used this technique for the first time to investigate the cardiac autonomic function of patients with acute hemispheric ischemic stroke.MethodsA 24-hour Holter monitoring was performed in 63 patients with first-ever acute ischemic stroke in hemisphere and sinus rhythm, as well as in 50 controls with high risk of stroke. DC, AC, heart rate variability parameters, standard deviation of all normal-to-normal intervals (SDNN), and square root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals (RMSSD) were calculated. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke. We analyzed the changes of DC, AC, SDNN, and RMSSD and also studied the correlations between these parameters and NIHSS scores.ResultsThe R–R (R wave to R wave on electrocardiogram) intervals, DC, AC, and SDNN in the cerebral infarction group were lower than those in controls (P=0.003, P=0.002, P=0.006, and P=0.043), but the difference of RMSSD and the D-value and ratio between absolute value of AC (|AC|) and DC were not statistically significant compared with those in controls. The DC of the infarction group was significantly correlated with |AC|, SDNN, and RMSSD (r=0.857, r=0.619, and r=0.358; P=0.000, P=0.000, and P=0.004). Correlation analysis also showed that DC, |AC|, and SDNN were negatively correlated with NIHSS scores (r=−0.279, r=−0.266, and r=−0.319; P=0.027, P=0.035, and P=0.011).ConclusionBoth DC and AC of heart rate decreased in patients with hemispheric infarction, reflecting a decrease in both vagal and sympathetic modulation. Both DC and AC were correlated with the severity of stroke.

Extracranial Carotid Artery Disease: Risk Factors and Outcomes in Patients With Acute Critical Hemispheric Ischemic Stroke.

The prevalence of carotid disease in stroke patients has been underestimated because most stroke patients who receive carotid sonography have already survived the acute event. Little is known about the extracranial carotid arteries of patients with acute stroke who need intensive care. This study reviewed color-coded carotid duplex sonographic examinations of the extracranial carotid arteries of patients with acute critical hemispheric ischemic stroke. We retrospectively reviewed 30 consecutive patients who had acute critical hemispheric ischemic stroke and received color-coded carotid duplex sonography in the intensive care unit. The presence of occlusive carotid artery disease was correlated with clinical features, vascular risk factors, and outcomes. Overall, 57% of the patients (17 of 30) had an occlusive internal carotid artery, and 44% of patients with atrial fibrillation (7 of 16) also had occlusive carotid disease. Eventually, 73% of the patients (21 of 30) had poor outcomes, and 57% (17 of 30) died. The contributing factors to a poor outcome were older age, an initial conscious disturbance, endotracheal intubation, and occlusive carotid disease, with the most significant factor being older age (P = .022; odds ratio, 27.76). The factors contributing to death were endotracheal intubation, occlusive carotid disease, and reversed ophthalmic flow, with the most significant factor being occlusive carotid disease (P = .014; odds ratio, 11.38). Soft homogeneously echogenic thrombi filling the lumen of the internal carotid artery and moving forward and backward with the carotid pulse were found in 3 patients. A small segment of ruptured plaque that was floating forward and backward with pulsation was found in 1 patient. Occlusive carotid artery disease is not uncommon among Chinese patients who have had an acute critical hemispheric infarction. Older age is the factor most significantly correlated with a poor outcome, and occlusive carotid disease is the factor most significantly correlated with death.

Anosognosia in patients with acute hemispheric ischemic stroke

Objective: to investigate the frequency of anosognosia (a deficit of self-awareness), its anatomic correlates associated with other neuropsychological and neurological disorders in acute hemispheric ischemic stroke (IS). Patients and methods 150 patients (83 men and 67 women; mean age, 63.0±9.3 years) with acute hemispheric IS were examined. All the patients underwent neurological, neuroimaging, and neuropsychological (by the procedure described by A.R. Luria) examinations. neuropsychological investigations. Anosognosia was diagnosed using the Dysexecutive Questionnaire (DEX) and the authors' procedure involving a scale to measure impaired self-rating of motor abilities and a scale to measure impaired self-rating of cognitive abilities in everyday life. Results and discussion. In the acute period of hemispheric IS, reduced self-awareness of motor and cognitive abilities was noted in 14% of the patients and unawareness of only cognitive abilities was recorded in 15%. Patients with anosognosia and cognitive dysfunction (ACD) and those with anosognosia and motor dysfunction (AMD) had right-sided hemispheric IS more frequently (76%) while this was not found in patients with isolated ACD. The development of anosognosia for paralysis and paresis was favored by the large sizes of an ischemic focus that involved a few lobes in the posterior regions of the brain although no lesions were found in the anosognosia-specific anatomical regions. ACD and AMD proved to be associated with unilateral spatial and tactile neglect and obvious regulatory dysfunction.